Application for Manufactured Home Community State of Michigan Michigan Form

General Instructions Per the Mobile Home Commission Act A person shall not operate a mobile home park or seasonal mobile home park without a license. Per Manufactured Housing General Rules Rule 204. An applicant shall file a change to a licensing application with the department within 30 days after the change is made. Rule 214k. 1 If a licensing application is for a new community or an expansion to an existing community then the applicant shall submit a completed application to the department on a form prescribed by the department. 2 If a licensing application is for a community that is or was licensed to another person then the applicant shall submit a completed application to the department on a form prescribed by the department not more than 30 days after the date the community is conveyed by deed or land contract. 3 After conveyance the applicant is responsible for operation of the community. Rule 214n* 1 Except as provided in subrule 2 of this rule before the department issues an initial license for a new community or adds additional home sites to the community s existing license all of the following shall be certified to be complete under the provisions of the act a Internal roads servicing the completed home sites. The owner may construct the final lift of the road in the next construction season if a bond covering the cost of constructing the final lift is delivered to the department before licensure. The bond shall be made payable to the State of Michigan* b Home site individual sidewalk. c Common sidewalks if provided servicing the completed home sites. D Parking servicing the home site. e Patios if provided* f Permanent foundations. g Internal road lighting servicing the completed home sites. H At a minimum the stabilization of the soil on the completed home sites to prevent as much as possible erosion and soil runoff* 2 Upon approval by the department all of the following may be constructed after licensing of a home site for the purpose of customizing the home site to a specific home a The home site individual sidewalk. B Parking on the home site. d Light fixture if on the home site. 3 The applicant shall file all of the following documents with the license application for a new community or additional home sites a An affidavit signed by the community owner or operator and an engineer or architect stating that the construction was completed according to the approved plans and specifications under the provisions of the act. If the community owner or operator elects to complete the home site under the provisions of subrule 2 of this rule then the affidavit shall specifically state that the home site construction shall be completed before the home is occupied and shall be 12 completed according to the approved plans and specifications. The affidavit shall cite the specific home sites to be licensed by home site number. b Certification of the community sewer system by home site number under the provisions of R 325. 3391. 4 Before the department may issue a license the department shall receive certification of the home sites by the Michigan department of environmental quality and the Michigan department of labor and economic growth under the provisions of the act. 5 It is a violation of this rule and the act if any home that is placed on a home site is occupied by residents before the home site is licensed* In a licensed community each home site that has a home occupied by residents shall be licensed whether or not it is being offered to the public* Manufactured Housing Retailer and Installer/Servicer Licenses A manufactured home community license is expressly for the operation of a community. Additional licenses for selling or installing and repairing manufactured homes must be applied for separately through the Bureau of Construction Codes Building Division* A Manufactured Home Retailer License allows for the business of offering manufactured homes for sale and a Manufactured Home Installer and Servicer License allows for the business of installing or disassembling the installation of homes or servicing a manufactured home for compensation* Certificate of Compliance As a condition of licensing pursuant to Executive order No* 2006-16 and Sections 16 3 and 17 1 of the Mobile Home Commission Act the Department of Licensing and Regulatory Affairs LARA is required to conduct annual inspections of manufactured housing and seasonal communities and grant certificates of compliance for the purpose of licensing* Inquiries regarding certification may be directed to LARA s Bureau of Construction Codes Building Division at 517-241-9317. Instructions for Application for Manufactured Home Community License Required Submittals for Community Licensing For each separate community submit completed application appropriate fee made payable to the State of Michigan and required documentation as stated below. Your application will not be processed if incomplete or without the required fees and documentation* There is no written test for this license. License Type Fee Documents New or Transfer of Existing Community License 225. 00 for 25 sites of less plus 3. 00 for each site in excess of 25 Legal documentation proving ownership to entity listed under Owner Information Additional Sites to an 3. 00 for each site include only if combined number of existing and additional sites exceeds 25 M Construction Affidavit C by site number from state or local plumbing authority electrical system by site number from state or local electrical authority Seasonal Community Transfer of Existing Community License Notes T ransfers shall be filed not more than 30 days after date community conveyed by deed or land contract. Ite s must be licensed prior to S resident occupying site. U pon receipt of applicable documents and fees the Building Division will conduct inspection of previously unlicensed sites. Licenses are issued in 3-year cycles which expire September 30. A renewal application is mailed to each licensee every 3 years in August and must be returned before October 1 with the applicable fees. All licensees are on the same 3-year cycle. Community Information Provide all requested information including the address for the physical location of the community not a post office location* If the owner is a foreign non-Michigan corporation limited liability company or limited or limited liability partnership and does not have P. O. Box 30054 Lansing MI 48909 517-241-6470. NOTE To obtain a Certificate of Assumed Name if the community owner is a corporation limited liability company limited partnership or limited liability partnership they will need to contact the Bureau of Commercial Services Corporation Division P. O. Box 30054 Lansing MI 48909 517-241-6470. If the owner is not one of the previously mentioned entities they will need to contact their county clerk s office. For partnerships except Limited and Limited Liability that do not have a Certificate of Assumed Name include a copy of the Operator Information Provide all requested information* All correspondence will be sent to this address and this entity will be directly responsible for the operation of the licensee as described in the Manufactured Housing General Rules the Rules including all fees. As defined in the Rules an Operator means an individual 18 years of age or older who is an officer of a corporation a manager or member if member managed of a limited liability company a general partner a copartner or a sole proprietor. Owner Information Provide all requested information* If the owner is a foreign non-Michigan corporation limited liability company or limited of Commercial Services Corporation Division P. O. Box 30054 Lansing MI 48909 517-241-6470. See NOTE above. If you have any questions regarding the license application contact the Bureau of Construction Codes Building Division at 517-241-9317. To obtain a copy of the Mobile Home Commission Act Manufactured Housing General Rules Manufactured Home Buyer s Resident s Handbook or additional forms visit our web site at www. Michigan*gov* Print Application for Manufactured Home Community License Michigan Department of Licensing and Regulatory Affairs Bureau of Construction Codes / Building Division 517-241-9317 Clear FOR OFFICE USE ONLY LICENSE NUMBER DATE ISSUED www. Michigan*gov/bcc This form can be completed by tabbing to each field and typing in the required information* FEE Authority 1987 PA 96 Completion Voluntary Penalty Failure to complete may result in denial of application LARA is an equal opportunity employer/program* Auxiliary aids services and other reasonable accommodations are available upon request to individuals with disabilities. Complete application* Type or print in ink. Failure to accurately complete the form may be reason for denial* Be sure to sign application* Make check or money order payable to the State of Michigan* Mail application all applicable documents and payment to the address listed above. Check One see instructions License Number Number of Sites New Community Changes to Original Application Must be filed within 30 days after the change is made COMMUNITY ENTITY ASSUMED NAME COMMUNITY TELEPHONE NUMBER Include Area Code COUNTY COMMUNITY LOCATION - STREET ADDRESS CITY PARCEL NO. STATE ZIP CODE MI NAME OF OPERATOR Last First Middle Initial Must be an individual BIRTH DATE MO / DAY / YEAR FEIN OR SOCIAL SECURITY NO. TELEPHONE NUMBER Include Area Code MAILING STREET ADDRESS STATE / PROVINCE ZIP CODE / POSTAL CODE COUNTRY IF NOT U*S* E-MAIL ADDRESS PREFERRED METHOD OF CONTACT/CORRESPONDENCE Check One E-Mail Regular Mail This information is confidential* Disclosure of confidential information is protected by the Federal Privacy Act. BCC-967 Rev* 10/13 Page 1 CHECK ONE If this application is being filed as a Corporation Limited Liability Company Limited Partnership or Limited Liability Partnership furnish the number assigned to you by the Michigan Department of Licensing and Regulatory Affairs Bureau of Commercial Services Corporation Division* Sole Proprietor Limited Partnership Number Partnership Other Type Corporation Number Complete the information below required for each member of the business entity checked above. Attach Additional Owner Information sheets as necessary. NAME Last First Middle Initial STREET ADDRESS FEDERAL ID NUMBER OR SOCIAL SECURITY NUMBER Disclosure Information Have any of the general partners or copartners in a partnership officers of a corporation managers or members if a member managed before the date of the application in connection with A. Any aspect of the business of homes which includes but is not limited to sales brokering installation servicing financing and insuring homes or any aspect of community ownership management operation development or construction Yes No If yes under the Mobile Home Commission Act and Manufactured Housing General Rules R 125. 1202b provide all information associated with the conviction or judgment. B. A violation of a statute regulating the offering of securities or franchises or regulating builders real estate brokers or real estate agents or a violation of 1972 PA 286 MCL 565. 801 to 565. 835 I hereby certify as operator sole proprietor general partner corporate officer or member or manager of the LLC I am authorized to make to the best of my knowledge. Any misleading incomplete or false statement shall be grounds for denial of this application* I stipulate and agree any legal process affecting the business served on the Manufactured Housing Commission shall have the same effect as if personally served on me and all other general partners or corporate officers of this business if any. I further agree this appointment shall remain in force as long as any liability of this business shall remain outstanding within the state of Michigan* Print Name of Operator Title Signature of Operator Required Date Additional Owner Information Continued List names and residence addresses of sole proprietor partners corporate officers and directors or LLC managers or members.